Bone graft forming guide

ABSTRACT

A bone graft forming guide for providing a bone graft and a method of forming a bone graft. The guide includes a main body including a holder for holding a graft material and guide containing a pattern generally corresponding to the desired shaped of the bone graft. The forming guide may include a hole guide containing a plurality of hole guides arranged in a pattern generally corresponding to the desired shape of the bone graft. The forming guide may further include a cutting guide containing a pattern corresponding to the desired shape of the bone graft.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of Ser. No. 09/742,923 now U.S.Pat. No. 06,648,894, filed on Dec. 21, 2000.

FIELD OF THE INVENTION

The present invention relates to bone grafts for use in the repair,replacement, and/or augmentation of various portions of animal or humanskeletal systems. More particularly, the present invention relates to aprepared bone graft, guides for forming bone grafts and methods offorming bone grafts.

BACKGROUND OF THE INVENTION

Several procedures involve the use and implantation of autograft bone,allograft bone or xenograft bone into an animal or human body. At leastsome of the benefits of implanted bone includes providing support,promoting healing, filling bony cavities, separating or spacing bonyelements such as vertebral bodies, promoting fusion, and stabilizing thesite of fractures.

In one known procedure, a donor bone from a cadaver is selected andprepared for insertion into a patient. For example, a spinal implant maybe prepared by selecting a femur or tibia bone and cutting the bone to adesired shape. Alternatively, a portion of a bone can be cut from thepatient receiving the implant, usually from a large bone such as a hipbone. In another known procedure, the bone graft can be a syntheticmaterial which has been formed to a desired size and shape.

Typically, bone grafts are prepared outside the operating room in aproduction facility, and inserts are prepared having a variety of shapesand sizes so that the physician performing a bone implant operation canselect a properly sized and shaped implant for each patient andprocedure. Production of bone graft can be expensive because theproduction facility must be capable of producing sterile implants, andthe bone graft must be stored prior to use in an operation.

For many procedures, it may be desirable to provide a roughened orirregular surface on at least one surface of the finished bone graft topromote fusion of the graft to adjacent bone in the body. In addition,during an operation requiring an insert having a very precise size andshape, for example, a discectomy and spinal fusion procedure, a surgeonmust have on hand a variety of bone graft sizes and shapes to preciselyfit the bone graft into the disc space of the patient after preparationof the bone graft, which may include surgical removal of a ruptured ordegenerated disc or a portion thereof.

Presently known methods for preparing bone grafts have shortcomings. Oneshortcoming is the cost of manufacturing bone grafts and sterilizing andstoring the bone grafts in a production facility. Another shortcoming isthe difficulty of forming a roughened or irregular surface on a bonegraft, particularly after the bone graft has been cut to a desired sizeand shape. Formation of the roughened or irregular surface typicallyrequires machining after cutting of the bone graft, and this may alterthe dimensions or shape of the bone graft.

In view of these and other shortcomings associated with providing bonegrafts, it would be desirable to provide an improved method andapparatus for the manufacture of bone grafts. Such a method should berelatively simple, inexpensive and provide the flexibility of allowingthe bone graft to be prepared intraoperatively in an operating room.

SUMMARY OF INVENTION

Accordingly, the present invention generally provides a relativelysimple bone graft forming guide and a method of forming a bone graft.The method includes the steps of selecting the shape of at least aportion of a bone graft and forming a plurality of holes in a graftmaterial. According to one aspect of the invention, the plurality ofholes forms a pattern generally corresponding to the intended shape ofthe bone graft. The invention may further include cutting at leastpartially through the graft material along the pattern formed by theplurality of holes.

According to one aspect of the invention, the cutting step includescutting through at least a portion of the plurality of holes resultingin a portion of the bone graft having a roughened surface. Anotheraspect of the invention includes providing a drill guide containing aplurality of hole guides arranged in a pattern generally correspondingto the intended shape of the bone graft. According to this aspect of theinvention, the method includes positioning the drill guide with respectto the graft material and drilling into the graft material using a leasta portion of the hole guides.

In another aspect of the invention, the method may further includeproviding a cutting guide having a pattern corresponding the intendedshape of the bone graft, positioning the cutting device with respect tothe graft material, and cutting the graft material using the cuttingguide. In another aspect, the drilling step includes drilling throughthe graft material and the cutting step includes cutting through thegraft material.

According to a preferred aspect of the invention, the method isperformed intraoperatively in an operating room. This aspect of theinvention provides the surgeon performing a bone graft insertionprocedure with the flexibility to select a properly sized and shapedbone graft in the operating room. According to prior art methods, asurgeon would have to purchase various differently sized and shaped bonegrafts that are fabricated in a facility outside the operating room. Forexample, according to one aspect of the invention, a spinal bone graftmay be formed in a generally elliptical shape with respect to thecutting direction. According to this aspect of the invention, the holeguide and the cutting guide have a pattern that is generally ellipticalin shape. According to another aspect of the invention, a spinal bonegraft can be produced that is generally cut in a wedge shape.

Another aspect of the invention pertains to a method of forming a bonegraft from a graft material including the steps of selecting the shapeof at least a portion of the bone graft, providing a graft materialholder and selecting from a plurality of cutting guides, each of thecutting guides having a different cutting pattern. According to thisaspect of the invention, the method further includes associating thecutting guide with the graft material holder and cutting at least aportion of the bone graft material using the cutting guide.

Another aspect of the invention involves a bone graft forming guide forproviding a bone graft having a desired shape. According to this aspectof the invention, the cutting guide has a main body including a holderfor holding a graft material and a cutting guide-receiving structure.This aspect of the invention also includes a cutting guide containing apattern corresponding to the desired shape of the bone graft, and thecutting guide adapted to be detachably mounted to the main body.

According to another aspect of the invention, the forming guide includesa main body having a holder for holding a graft material and a holeguide containing a plurality of hole guides arranged in a patterngenerally corresponding to the desired shape of the bone graft. Theforming guide further includes a cutting guide containing a patterncorresponding to the desired shape of the bone graft.

In one aspect of the invention, the hole guide is an insert and the mainbody includes a guide receiving opening to receive the insert. Inanother aspect, the cutting guide is an insert and the main bodyincludes an opening to receive the insert. According to this aspect ofthe invention, the forming guide includes a securing mechanism forremovably securing one or both of the hole guide insert or the cuttingguide insert in the opening.

In a preferred embodiment, the securing mechanism includes a cam memberassociated with the main body. Preferably, the cam member cooperateswith one or both of the hole guide insert or the cutting guide insert tosecure one or both of the inserts to the main body. In another aspect ofthe invention, the hole guide insert and the cutting guide insertinclude a ridge adapted to cooperate with the cam member.

According to one aspect of the invention, the main body of the bonegraft forming guide includes a block adapted to receive a graftmaterial. Preferably, the block includes two members connected by ahinge. Preferably, the main body further includes a closure means suchas a clamping mechanism for clamping the two members towards each otherto secure the bone within the cutting guide. Preferably, the clampingmechanism includes a threaded rod and nut assembly.

According to another aspect of the invention, the forming guide includesa handle and a shaft having a proximal end and a distal end. Theproximal end of the shaft is attached to the handle, and a pair of jawsextends from the distal end of the shaft. The jaws are movable between agripping position to grip graft material during cutting of the bonegraft and a releasing position to release the implant. According to thisaspect of the invention, the handle includes pair of arms connected tothe pair of jaws to provide a pair of gripping members that arepivotally joined. Preferably, the pair of arms includes a lockingmechanism to lock the cutting guide in a plurality of positions.According to this aspect, the cutting guides are attached to at leastone of the jaws. In a preferred aspect, the hole guide and the cuttingguide are removable inserts. Alternatively, the hole guide and thecutting guide may be integrally formed in at least one of the jaws.

Another aspect of the invention relates to a bone graft forming guideincluding a handle and a shaft having a proximal end and a distal end.The proximal end of the shaft is attached to the handle, and a pair ofjaws extends from the distal end of the shaft. According to this aspectof the invention, a cutting guide is associated with the jaws, and thejaws are movable between a gripping position to grip graft materialduring cutting of the bone graft and a releasing position to release theimplant. Preferably, the handle includes a pair of arms connected tosaid pair of jaws to provide a pair of gripping members, the grippingmembers being pivotally joined.

The present invention provides a relatively simple and inexpensive wayto make bone grafts. A surgeon can select a from a variety of holeguides and cutting guides to provide various sized and shaped bonegrafts for a procedure. Advantageously, the method and forming guide ofthe invention can be used intraoperatively in an operating room setting.By forming a plurality of holes in the graft material prior to cuttingof the graft material, a roughened surface is provided on at least onesurface of the bone graft. In one preferred aspect of the invention, thehole guides contain round holes, and the cutting guide is positionedsuch that the cutting device cuts through the approximate center of theholes to provide a roughened or ridged surface on at least one surfaceof the bone graft. The roughened surface promotes ease of insertion ofthe graft and fusion of the bone graft to an adjacent bone afterinsertion in the body.

Additional features and advantages of the invention will be set forth inthe description which follows. It is to be understood that both theforegoing summary and the following detailed description are exemplaryand are intended to provide further explanation of the invention asclaimed. In the following drawings, like reference characters denotesimilar elements throughout the several views.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an exploded perspective view of a bone graft forming guide inan open position and a bone graft material according to one aspect ofthe invention.

FIG. 2 is a perspective view of the forming guide of FIG. 1 in a closedposition showing the bone graft material and a cutting insert inassociation with the forming guide.

FIG. 3 is a top plan view of a forming guide according to one aspect ofthe invention.

FIG. 4 is a front view of the forming guide of FIG. 2.

FIG. 5 is a cross-section view taken along line 5-5 of FIG. 2.

FIG. 6 is a perspective view of a bone graft in accordance with theinvention.

FIGS. 7A-7D show top views of examples of cutting inserts in accordancewith the present invention.

FIG. 8 is a perspective view of a bone graft forming guide according toanother embodiment of the invention; and

FIG. 9A-9C shows a partial perspective view of bone graft forming guidesaccording to other embodiments of the invention.

DETAILED DESCRIPTION

An exemplary embodiment of the present invention is shown in FIGS. 1-7and is designated generally by reference numeral 10. As embodied hereinand referring to FIG. 1, a bone graft forming guide 10 for forming abone graft having a desired shape includes a main body 12 and a cuttingguide 14. In this embodiment, the main body is in the form of a block ofmaterial adapted to receive and, preferably, position a graft material.Preferably, the block of material comprises two members 22 and 24connected by a hinge.

As best shown in FIGS. 1 and 5, the hinge preferably includes a pin 28,which cooperates with hinge members 30 and 32 associated with main bodymembers 20 and 22 to join the two members together and provide an axisof rotation for opening and closing the forming guide in use. It will beappreciated, of course, that the invention is not limited by arequirement for separate body members or a requirement for a particularmeans of joining the members together or a specific hinge member. Forexample, the two members 20 and 22 may be joined together by a livinghinge (not shown), wherein during the manufacturing process of theforming guide, a thinned section is provided that functions as a hingeand allows the two members to open and close. Other types of hinges arealso within the scope of the invention, such as, for example, a pianohinge. Or, there may be no hinge at all, the two members being joined byany number of mechanical means.

As will be described in more detail below, the cutting guide 14 has acutting pattern corresponding to the desired shape of the bone graft.The main body 12 of the forming guide 10 includes a holder 16 forholding bone graft material 18 during formation of the bone graft. Theholder 16 may include a plurality of splines 34 on the inner surface ofthe main body for holding the bone graft material 18 during the formingoperation. Preferably, the splines 34 are adapted to at least partiallydeform when they contact the graft material 18 and hold it in placeduring cutting of the bone graft material into a desired shape.

According to a preferred aspect of the invention, the cutting guide 14is adapted to be detachably mounted to the main body 12 of the formingguide. One example of various ways in which the cutting guide 14 can bedetachably mounted to the main body 12 is to provide a cuttingguide-receiving structure 20 associated with the main body 12, as shownin FIGS. 1-3. For example, as shown in FIG. 1, the cuttingguide-receiving structure 20 may be an opening or nesting structure andthe cutting guide 14 may be in the form of an insert sized to fit withinthe opening or nesting structure.

Referring now to FIG. 7A and 7C, in another aspect of the invention, thebone graft forming guide includes a hole guide 36 containing a pluralityof hole guides 38 arranged in a pattern generally corresponding to thedesired shape of the bone graft. According to this aspect of theinvention, the hole guide 36 and the cutting guide 14 may be selected asa pair having a similarly shaped pattern for forming a bone graft. Forexample, hole guide insert 36 a shown in FIG. 7A would desirably be usedwith the cutting guide insert 14 b shown in FIG. 7B as described furtherbelow to provide a bone graft having a wedge shape. Similarly, the holeguide insert 36 d shown in FIG. 7D would be used with the cutting guideinsert 14 c shown in FIG. 7C to provide an elliptically shaped bonegraft, as will be described further below. It will be understood, ofcourse, that in accordance with the present invention, a wide variety ofpatterns can be provided in the hole guide and cutting guide to providevarious shaped bone graft. The present invention desirably provides theadvantage of enabling the surgeon to custom select the size and shape ofa bone graft in the operating room to fit the graft to a particularpatient and/or procedure.

Thus, according to the present invention, a bone graft forming guide isprovided that includes at least a main body having a holder for holdinga bone graft material and a cutting guide containing a patterncorresponding to the desired shape of the bone graft. According to thisaspect, the cutting guide is detachably mounted to the main body of theforming guide. In an alternative embodiment described above, the formingguide may optionally include a complementary hole guide for use with thecutting guide, the hole guide insert also adapted to be detachablymounted to the main body of the forming guide.

Referring now to FIG. 6, use of a hole guide is desirable to provide abone graft 38 having a roughened or irregular surface 40 on at least aportion of the bone graft 38. As is known in the art, it is desirable toprovide a roughened surface on a portion of a bone graft to prevent thebone graft from backing out after insertion and promote fusion of theinsert to adjacent tissue. For example, in a spinal fusion procedure, aruptured disc may be replaced with a bone graft, and the portions of thebone graft contacting the adjacent vertebrae may desirably be roughenedto promote fusion of the insert to the adjacent vertebrae. The presentinvention provides a simple and inexpensive method of forming a bonegraft having a roughened surface.

According to another aspect of the invention (as shown in FIG. 3), thebone graft forming guide includes a securing mechanism 42 for removablysecuring one or both of the hole guide insert or the cutting guideinsert in the cutting guide-receiving structure 20, which may be in theform of an opening or nesting structure adapted to receive the inserts.Preferably, the securing mechanism 42 includes a cam member associatedwith the main body 12 of the forming guide. The cam member 42 cooperateswith one or both of the hole guide insert or the cutting guide insert 14b to secure the inserts to the main body 12. As shown in FIG. 1, theinsert may optionally include a ridge 44 adapted to cooperate with thecam member to detachably secure the insert to the main body.

The forming guide preferably further includes a closure means such as aclamping mechanism 46 for moving the two members 22 and 24 towards eachother to secure a bone graft material within the forming guide. As bestshown in FIG. 1 and FIG. 4, the clamping mechanism 46 may include athreaded rod 47 and nut 49 assembly. A bottom portion of the threadedrod 47 may be secured to one of the members 22 in a manner to allow thethreaded rod to pivot about the member 22 to move the threaded rod intoand out of engagement with the other member 24. After the threaded rodis moved into engagement with the other member 24, the nut assembly 49may be rotated until the bone graft material 18 is securely held in theholder 16 of the main body 12 (as shown in FIG. 2 and FIG. 5).

Of course, it will be understood that other closure means are within thescope of the invention. For example, the closure means can include alatch and hook assembly that is adapted to bias the two members 22 and24 of the main body 12 together and hold bone graft material 18 in theforming guide. Alternatively, the closure means could include strapmembers that could be tightened to bias the two members 22 and 24together. In addition, the closure means could be provided by screwingor bolting the main body members together, or any other suitable closuremeans could be used to bias the main body members together to hold thebone graft material in place during forming of the bone graft.

In use, the bone graft forming guide is preferably used intraoperativelyin an operating room where a bone graft insertion procedure isperformed. A surgeon would have on hand a bone graft material, forexample, a donor tibia bone as shown in the Figures, or the surgeonwould cut a portion of bone from the patient or obtain a syntheticallyformed bone graft material. The surgeon would determine the size andshape of the bone graft that was needed for the particular procedure andthe patient and then cut the bone graft as follows.

According to one embodiment, the surgeon would place the bone graftmaterial 18 in the holder 16 of the forming guide 10 and select from aplurality of cutting guides provided to the surgeon in advance. Thesurgeon would select the cutting guide insert that would provide theproperly sized and shaped bone graft for the patient and the particularprocedure. The surgeon or assistant would then associate the cuttingguide with the graft material holder, preferably by inserting a cuttingguide insert in the opening sized to receive the cutting guide insert.The cutting guide insert would then be secured to the main body of theforming guide by the cam member or other appropriate securing mechanism.The clamping mechanism would then be engaged to bring the two members 22and 24 of the main body 12 together and hold the bone graft material 18in place during cutting of the bone graft. The bone graft material wouldthen be at least partially cut along the pattern contained in thecutting guide to provide a bone graft having a desired shape. Cuttingcan be performed using any appropriate cutting device known in the art,such as a sagittal saw.

If it is desirable to provide a roughened or irregular surface on atleast a portion of the bone graft, the step of cutting the bone graft ispreferably preceded, but may be followed, by forming a plurality ofholes in a graft material, the plurality of holes forming a patterngenerally corresponding to the shape of the bone graft. In theembodiments shown in FIGS. 1-7, this can easily be achieved by firstinserting a hole guide insert in the insert-receiving opening in themain body, securing the insert with the securing mechanism, and thenforming a plurality of holes in the bone graft material by using atleast a portion of a plurality of the holes in the drill guide. As usedin this disclosure, the term “drill” and “drilling” is not intended tobe used in a limited manner to mean only traditional drill devices knownin the art. Forming the plurality of holes may be accomplished by usinga traditional drilling device and drill bits, or by other suitablemachining methods such as by laser or ultrasonics.

In one embodiment, after a plurality of holes have been formed in thegraft material, the hole guide insert may be removed from the opening inthe main body, and a cutting guide insert may be placed in the opening.The cutting guide is then secured to the main body, and the cuttingoperation is performed as described above. As one example, the resultingbone graft may appear as shown in FIG. 6, having a roughened surface 40.As mentioned above, the present invention provides the flexibility ofproviding a wide variety of bone graft shapes, including, but notlimited to, grafts that are straight, wedge-shaped, and ellipticallyshaped.

According to additional embodiments of the invention shown in FIGS. 8and 9, the bone graft forming guide 60 has a handle 64 having a proximalend 74 and a distal end 76. According to this embodiment, a pair of jaws78 and 80 extends from the distal end 76 of the handle 72. The jaws aremovable between a gripping position to grip graft material duringcutting of the bone graft and a releasing position to release the graftmaterial (not shown). Preferably, the handle 74 includes a pair of armsconnected to the pair of jaws 78 and 80 to provide the pair of grippingmembers, and the gripping members are pivotally joined by pivot point82. Preferably, the pair of arms includes a locking mechanism 84 to lockthe forming guide 60 in a plurality of positions. These positions couldinclude, for example, a closed position when the jaws are locked aroundthe bone graft material during the cutting operation.

In a preferred aspect according to this embodiment, the hole guideand/or cutting guide are attached to at least one of the jaws that makeup the pair of jaws. As shown in FIG. 8, the hole guide may beintegrally formed as part of the jaw. Alternatively, the hole guideand/or the cutting guide may be detachably mounted to at least one ofthe jaws as shown in FIG. 9 a. As shown in FIG. 9A, attachment of theguides may be accomplished by screwing the guide to jaws, or by otherappropriate means.

The guide may also be associated with the jaws by providing an insertreceiving structure in the jaw and a hole guide insert and/or a cuttingguide insert which fits into the insert similar to the insert receivingstructure shown in FIGS. 1-7. Of course, if an insert structure is used,a securing mechanism may be included to secure the insert in to the jaw.Such securing mechanisms can include a cam mechanism, a ball and springdetent structure, snap, clips, or any other mechanism for securing theinserts in the insert receiving structure during cutting and forming ofthe bone graft.

As shown in FIGS., 9 b and 9 c, the inserts may be provided in a varietyof shapes and sizes. FIG. 9 b shows a cutting guide insert for making awedge-shape. FIG. 9 c shows a combination hole-guide and cutting guideinsert having a pattern of hole guides and cutting guides generally inthe shape of an ellipse to form a elliptically-shaped bone graft.

In use, the embodiments shown in FIGS. 8 and 9 can be usedintraoperatively in an operating room setting. Desirably, the surgeoncan be provided with several forming guides having a variety of sizedand shaped hole and cutting guides. The surgeon would determine theproper size and shape of the bone graft needed for the procedure. A bonegraft material, such as a donor bone, would be gripped between the jawsof the forming guide, and the surgeon or assistant would apply pressureto the handles so that the jaws close on the bone graft material. Thesecuring mechanism would lock the jaws in place, and the bone graftmaterial could be cut to the desired shape using an appropriate cuttingdevice such as a sagittal saw.

If it is desired to provide a bone graft implant having a roughenedsurface, forming holes in the graft material using at least a portion ofthe holes in a hole guide would precede the step of cutting the bonegraft material. If the forming guide includes a combination holeguide/cutting guide in the jaw as shown in FIG. 9 c, the bone could bedrilled and cut using the same forming guide without having to releasethe bone graft material from the forming guide between the drilling andcutting steps. However, if the forming guide does not include acombination drill guide/cutting guide separate forming guides (oneincluding a drill guide, the other including a cutting) would beutilized. Alternatively, a forming guide having detachable inserts couldbe used and the drill guides would be detached from the jaws after thedrilling step and the cutting guides would be attached to the jaws priorto the cutting step.

The material for making the forming guide according to the presentinvention can be any material having the proper rigidity and strengthfor holding the bone graft material during the cutting and formingoperations. Accordingly, plastic, metals, ceramics, composite materials,and combinations thereof can be utilized to form the various parts ofthe forming guide. If it is desired to reuse the forming guide, thematerials used to construct the forming guide should be designed towithstand sterilization procedures.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the forming guide and themethod of the present invention without departing from the spirit orscope of the invention. Thus, it is intended that the present inventioncover the modifications and variations of this invention provided theycome within the scope of the appended claims and their equivalents.

1. A bone graft forming guide for providing a bone graft having adesired shape comprising: a main body including first and secondportions defining an interior for holding a graft material; a holeinsert guide containing a plurality of holes arranged in a hole patterngenerally corresponding to the desired shape of the bone graft, the holepattern allowing for holes to be made along first and second spacedapart portions of the perimeter of the bone graft while the graftmaterial is disposed within the interior; and a cutting guide containinga cutting pattern corresponding to the desired shape of the bone graft,the cutting pattern allowing for cuts along at least first and secondspaced apart portions of the perimeter of the bone graft while the graftmaterial is disposed within the interior, wherein the main body includesa guide receiving opening for the insert.
 2. The bone graft formingguide of claim 1, wherein the cutting guide is an insert and the mainbody includes a guide receiving opening for the insert.
 3. The bonegraft forming guide of claim 1, wherein said cutting guide is detachablymounted to said main body.
 4. The bone graft forming guide of claim 3,wherein said cutting pattern of said cutting guide comprises a pluralityof bores.
 5. The bone graft forming guide of claim 4, wherein saidplurality of bores are interconnected.
 6. The bone graft forming guideof claim 3, wherein said cutting pattern of said cutting guide comprisesat least one slot.
 7. The bone graft forming guide of claim 3, whereinsaid main body further comprises a mounting structure to facilitatedetachably mounting said cutting guide to said main body.
 8. The bonegraft forming guide of claim 7, wherein said main body further comprisesa securing element to secure said cutting guide to said mountingstructure.
 9. The bone graft forming guide of claim 1, wherein saidfirst and second portions are hinged together, and wherein each havebone graft material contacting surfaces, and wherein at least one ofsaid bone graft material contacting surfaces is deformable to facilitateholding said bone graft material when said bone graft material isclamped between said first and second hinged portions of said main bodyof said instrument.
 10. The bone graft forming guide of claim 9, whereinsaid at least one of said bone graft material contacting surfaces hasprotrusions.
 11. The bone graft forming guide of claim 9, wherein saidat least one of said bone graft material contacting surfaces isnon-linearly configured to accommodate a cross-sectional shape of saidbone graft material.
 12. The bone graft forming guide of claim 1,wherein said first and second portions each have bone graft materialcontacting surfaces, and wherein at least one of said bone graftmaterial contacting surfaces is non-linearly configured to accommodate across-sectional shape of said bone graft material.
 13. The bone graftforming guide of claim 1, wherein said pattern of said cutting guidecomprises a plurality of bores.
 14. The bone graft forming guide ofclaim 13, wherein said plurality of bores are interconnected.
 15. Thebone graft forming guide of claim 1, wherein said pattern of saidcutting guide comprises at least one slot.
 16. The bone graft formingguide of claim 1, wherein the first and second portions have respectiveends pivotally connected together.
 17. A bone graft forming guide forproviding a bone graft having a desired shape comprising: a main bodyincluding a holder for holding a bone graft material, the main bodyincluding a first portion and a second portion, at least one end of thetwo portions being joined together to provide a holder for holding agraft material during cutting, the main body having a receivingstructure adapted to receive an insert; a hole guide insert associatedwith the main body, the hole guide insert containing a plurality ofholes, the plurality of holes forming a hole pattern generallycorresponding to the desired shape of the bone graft, the hole patternallowing for holes to be made along first and second spaced apartportions of the perimeter of the bone graft; and a cutting guide insertassociated with the main body, the cutting guide insert containing acutting pattern corresponding to the desired shape of the bone graft,the cutting pattern allowing for cuts along at least first and secondspaced apart portions of the perimeter of the bone graft; wherein saidhole guide insert and said cutting guide insert are interchangeable. 18.The bone graft forming guide of claim 17, wherein the hole guide insertand the cutting guide insert are removably insertable within thereceiving structure.
 19. The bone graft forming guide of claim 18,further including closure means for closing the two portions of the mainbody together to hold a bone graft material during forming of the bonegraft.
 20. The bone graft forming guide of claim 19, wherein saidreceiving structure further includes a cam member.
 21. The bone graftforming guide of claim 17, wherein said receiving structure is anopening in said main body, said opening sized to fit only one of saidhole guide insert or said cutting guide insert at any given time. 22.The bone graft forming guide of claim 17, wherein only the hole guideinsert or only the cutting guide insert can be associated with the mainbody at one time.
 23. The bone graft of claim 17, wherein the first andsecond portions have respective ends pivotally connected together.
 24. Abone graft forming guide for providing a bone graft having a desiredshape comprising: a main body including a holder for holding a bonegraft material, the main body including a first portion and a secondportion, at least one end of the two portions being joined together toprovide a holder for holding a graft material during cutting, the mainbody having a receiving structure adapted to receive an insert; a holeguide insert associated with the main body, the hole guide insertcontaining a plurality of holes, the plurality of holes forming a holepattern generally corresponding to the desired shape of the bone graft,the hole pattern allowing for holes to be made along first and secondspaced apart portions of the perimeter of the bone graft; a cuttingguide insert associated with the main body, the cutting guide insertcontaining a cutting pattern corresponding to the desired shape of thebone graft, the cutting pattern allowing for cuts along at least firstand second spaced apart portions of the perimeter of the bone graft; andclosure means for closing the two portions of the main body together tohold a bone graft material during forming of the bone graft; wherein thehole guide insert and the cutting guide insert are removably insertablewithin the receiving structure.
 25. An instrument for use in forming abone graft from bone graft material, said instrument comprising: a bodyincluding first and second portions, each of said first and secondportions having bone graft material contacting surfaces, said first andsecond portions being hinged together and defining an interior capableof holding said bone graft material; a pattern guide associated withsaid body, wherein said pattern guide facilitates forming a pattern insaid bone graft material corresponding to a desired shape of said bonegraft, the pattern allowing for holes to be made along first and secondspaced apart portions of the perimeter of the bone graft while the graftmaterial is disposed within the interior; and a cutting guide associatedwith said body, wherein said cutting guide facilitates cutting throughsaid pattern in said bone graft material to form said desired shape ofsaid bone graft while the graft material is disposed within theinterior; wherein at least one of said bone graft material contactingsurfaces is deformable to facilitate holding said bone graft materialwhen said bone graft material is clamped between said two hingedportions of said body of said instrument.
 26. The instrument of claim25, wherein said at least one of said bone graft material contactingsurfaces has protrusions.
 27. The instrument of claim 25, wherein saidat least one of said bone graft material contacting surfaces isnon-linearly configured to accommodate a cross-sectional shape of saidbone graft material.